Assessment of Social Connection among Autistic and Non-Autistic Adults: A Proof of Concept Study for the Connections with Others Scales.

BACKGROUND: A gap exists in measures available to assess levels of motivation, desire, and value associated with connecting with others. Moreover, few social connection scales have been developed with a goal of including autistic individuals in the sample to create a measure that has utility across neurodiverse populations. This study aims to develop a measure to assess different facets of social connection that is valid among both autistic and non-autistic adults. METHODS: The sample consisted of 200 participants recruited online. Participants completed an initial set of 35 items. Exploratory factor analyses and confirmatory factor analyses were performed. Four-factor models were produced by the EFAs. RESULTS: Item reduction resulted in the development of two 8-item scales: the Connections with Others Scale (CWOS) intended for the general population and the CWOS-Autistic Version (CWOS-AV) intended for autistic populations (CWOS-AV). Autistic participants had significantly greater motivation/desire to connect with others compared to non-autistic participants (t(195) = 3.39; p < 0.001). CONCLUSIONS: These measures will allow for greater ability to assess the motivation to connect with others, resulting in improved ability to produce research that clarifies theories and describes psychological phenomena.

Investigation into the relationships between Greek life, experiences of violence, and suicidal thoughts and behaviors among undergraduate students.

Introduction: This study aims to examine how involvement in Greek life impacts the relationships between violence and STBs. Methods: This study utilizes data from the American College Health Association-National College Health Assessment (ACHA-NCHA) waves IIb, IIc, and III. Analyses examine the moderating effect of involvement in Greek life on the relationship between violence and presence of STBs in the past year. Results: Main effects revealed consistent patterns across violence types, STBs and waves, with Greek life membership associated with increased odds of experiencing violence and associated with decreased odds of suicidal ideation. The relationship between violence and suicide attempts was stronger for those involved in Greek life. Discussion: Greek life may be an institution where targeted interventions for suicide and violence may be effective. It may be important to identify additional avenues to reduce STBs that are not associated with increased experiences of violence.

The impact of measurement on clinical trials: Comparison of preliminary outcomes of a brief mobile intervention for autistic adults using multiple measurement approaches.

Initial studies of the emotional safety plan (ESP), a new, brief telehealth and mobile intervention to support autistic adults to cope with periods of distress, have reported feasibility and acceptability (Bal et al., 2023, Autism, 1-13). Herein we report the preliminary clinical outcomes of thirty-six autistic adults who developed a personalized ESP, with a specific interest in comparing "outcomes" demonstrated by different instruments and assessment frequencies in order to inform outcome measurement in future clinical trials. Comparison of pre-intervention baseline to post-monitoring outcome (pre-post) anxiety symptoms (Generalized Anxiety Disorder-7 [GAD-7]) and depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]) revealed medium effect sizes for reduction in symptoms, though, low effect sizes were observed for pre-post Adult Self-report Anxiety and Depressive Problems scales and the Emotion Dysregulation Inventory Reactivity and Dysphoria scales. Weekly assessments showed an initial decrease in GAD-7 anxiety symptoms but no effect on weekly PHQ-9 depressive ratings. Ecological momentary assessment (EMA) data suggested that, when participants reported feeling sad or agitated and used the ESP, reduced negative feelings and increased positive states were reported in subsequent EMA. Perhaps not surprisingly, preliminary outcomes of these feasibility trials differed depending on measure chosen. Implications for the design of clinical trials are discussed.

A systematic review and meta-analysis on the efficacy of sleep interventions to treat suicidal ideation.

Researchers at the intersection of sleep and suicide research have advocated for investigation of sleep disturbances as a therapeutic target for the purposes of treating and preventing suicide. This study aims to provide the first systematic review and meta-analysis on the efficacy of sleep interventions to treat suicidal ideation. This systematic review and meta-analysis, registered with the International Prospective Register of Systematic Reviews, was conducted in PsycINFO, through Ovid. A sample of eight articles were deemed eligible and a total of 21 effect sizes were included. Egger's test suggested that no publication bias was present (b = 0.3695; p = 0.0852). The pooled effect size for sleep treatments on suicidal ideation was small (g = -0.0931, p = 0.3047). Significant heterogeneity was present (I2 = 44.13%), indicating the need for moderator analyses. Treatment type (medication versus psychotherapy; g = -0.2487, p = 0.3368), sex (g = -0.0007; p = 0.9263), and race (g = -0.0081; p = 0.1624) were all considered as moderators and were all found to be insignificant. This meta-analysis revealed that initial studies exploring the efficacy of sleep interventions on suicidal ideation demonstrate small effect sizes. Despite this, the handful of studies included in this review nonetheless highlight this as an important area for continued exploration. The use of larger and more diverse samples, as well as intentionally designing sleep-related interventions to improve ideation and behaviour, have the potential to enhance the efficacy of sleep interventions for this novel purpose.

The emotional support plan: Feasibility trials of a brief, telehealth-based mobile intervention to support coping for autistic adults.

LAY ABSTRACT: Autistic adults may have difficulty coping during stressful periods, which could make them more vulnerable to depression and anxiety. We designed the emotional support plan (ESP) to help autistic people find ways to cope in stressful situations. Thirty-six autistic adults created an ESP and answered questions about their opinions of the ESP. Most autistic adults found the ESP to have a positive impact on them and many would recommend the ESP to another person. Feedback from autistic adults suggested ways that we might test the ESP in future studies. Overall, autistic adults in this study found the ESP to be useful and a worthwhile intervention to study more in the future. While more research is clearly needed, we hope that the brief nature of the ESP will make it helpful for autistic people who are trying to handle negative feelings during stressful life events.

Associations between feelings of safety, concerns about firearms on campus and suicidal thoughts and behaviours among college students.

BACKGROUND: Perceptions of safety on campus may be related to a variety of factors such as concerns about campus violence, especially firearm violence, and mental health, particularly suicidal thoughts and behaviours (STBs). The present analyses aim to describe associations between feelings of safety, concerns about firearms on campus and STBs among college students. METHODS: This study uses data from the American College Health Association-National College Health Assessment wave III (n=24 682 participants across k=29 schools). Multilevel logistic regressions and cumulative link mixed models examine the associations between feelings of safety, concerns about firearm violence on campus and presence of STBs in the past year. RESULTS: Participants who reported being concerned about firearm violence felt significantly less safe. Feeling unsafe at night was significantly associated with suicidal ideation and suicide attempts. Individuals with concerns about firearm safety on campus were up to 42% more likely to report suicidal ideation compared with those reporting they were not at all concerned about campus firearm violence. DISCUSSION: With associations highlighting increased risk of STBs among those with reduced safety feelings and heightened concerns about firearms, there is a need for college campuses to intervene and promote campus safety, with particular consideration for the presence of firearms on campus and the implications of allowing such weapons to be present in environments with increasing instances of firearm violence.

Concordance Between the Ask Suicide Screening Questions (ASQ) and Self-Injurious Thoughts and Behaviors Interview-Self Report (SITBI-SR) Among Autistic and Non-Autistic Adults.

OBJECTIVE: This study sought to examine concordance between two commonly used measures of suicidal thoughts and behaviors: the Ask Suicide-Screening Questions (ASQ) and the Self-Injurious Thoughts and Behaviors Interview-Self Report (SITBI-SR). Agreement was operationalized as the presence past month suicidal ideation and lifetime suicide attempts. To explore the utilization of these tools among neurodiverse samples, we also examined the concordance across autistic and non-autistic adults. METHODS: The sample consisted of 200 individuals recruited online. Half of the sample self-reported a diagnosis of autism. A series of Cohen's kappas and confidence intervals were computed to assess agreement between the ASQ and SITBI-SR. Cohen's kappa was computed separately for each set of comparisons for the autistic and non-autistic samples. RESULTS: Past month suicidal ideation had a kappa of 0.61 (95%CI = 0.48-0.73). The kappa for lifetime suicide attempts was 0.86 (95%CI = 0.78-0.94). There were no significant differences in agreement between the two measures for autistic versus non-autistic individuals. CONCLUSIONS: Current findings suggest that the ASQ and SITBI-SR have high concordance with one another. Given that the ASQ and the SITBI-SR are both validated in the general population and that concordance was high and not significantly different based on autism status, the current study provides preliminary evidence that the ASQ and the SITBI-SR function similarly for autistic individuals.HIGHLIGHTSPeople do not always respond consistently to different STB assessment methods.Findings suggest that the ASQ and SITBI-SR have high concordance with one another.Evidence provided that these measures function similarly for autistic individuals.

Internet-Based Mental Health Survey Research: Navigating Internet Bots on Reddit.

This study was a multistage process of recruiting participants through Reddit with the intent of increasing data integrity when facing an infiltration of Internet bots. Approaches to increase data integrity centered around preventing the occurrence of Internet bots from the onset and increasing the ability to identify Internet bot responses. We attempted to detect bots in a study focused on understanding social factors related to autism and suicide risk. Four recruitment rounds occurred through Reddit on mental health-related subreddits, with one post made on each subreddit per recruitment round. We found high presence of bots in the initial rounds-indeed, using location data, one third of the total responses (33.4 percent; 118/353) came from just eight locations (i.e., 4.7 percent of all locations). The proportion of detected bots was significantly different across the rounds of recruitment (χ2 = 150.22, df = 3, p < 0.001). In round 4, language advertising compensation was removed from recruitment posts. This round had significantly lower proportions of detected bots compared with round 1 (χ2 = 33.01, df = 1, p < 0.001), round 2 (χ2 = 129.14, df = 1, p < 0.001), and round 3 (χ2 = 46.6, df = 1, p < 0.001). Through a multistage recruitment process, we were able to increase the integrity of our collected data, as determined by a low percentage of fraudulent responses. Only once we removed advertisement of compensation in recruitment posts, did we see a significant decrease in the quantity and percentage of Internet bot responses. This multistage recruitment study provides valuable information regarding how to adapt when an online survey study is infiltrated with Internet bots.

Reflections on experiential training in meaning-centered psychotherapy: How MCP ended up facilitating professional wellbeing.

OBJECTIVE: Meaning-centered psychotherapy (MCP) principles may provide a framework for engaging healthcare professionals in meaning-centered exploration as a novel approach to prevent burnout and enhance wellbeing in healthcare professionals through heightening personal meaning. This case study aimed to teach MCP to masters-trained social workers for use with medical patients. While the primary aim was to teach MCP to masters-trained social workers, this proof-of-concept project and this paper focus on a secondary aim of enhancing meaning and connection in the virtual workplace. METHODS: A group of social workers participated in a 7-session MCP pilot from October 13th to November 24th, 2020. After each session, participants were asked to complete an anonymous continuing education evaluation with questions regarding clarity, organization, and relevance of the presentation related to use with their patient populations. Additional open-ended items queried participants for general comments about their experience using MCP to enhance professional fulfillment during COVID-19. RESULTS: Nine social workers participated in the MCP pilot. Several qualitative themes emerged, including enhanced meaning, communication, connection, and agency in the virtual workplace. SIGNIFICANCE OF THE RESULTS: This pilot demonstrated the feasibility and acceptability of using an adapted MCP instruction with hospital-based social workers during the COVID-19 pandemic to facilitate wellbeing. While MCP was originally created to intervene with patients with life-threatening illnesses, the brief, manualized experiential nature of the intervention lends itself to modification with staff for the purpose of enhancing meaning and community in their own lives.

A Closer Look: Examination of Suicide Risk Screening Results and Outcomes for Minoritized Youth in Subspecialty Pediatrics.

OBJECTIVE: To describe a sample of minoritized youth who screened positive for suicide risk within medical subspecialty pediatrics, compared to non-minoritized youth and describe the screening outcomes of these youth. METHODS: This retrospective chart review from October 2018 to April 2021 used electronic medical record data from an academic pediatric medical subspecialty clinic that screens universally for suicide risk for all patients ages 9 and up. Chart reviews were conducted for 237 minoritized youth (operationalized as identifying as non-White or Hispanic/Latinx, identifying as a gender minority, and having a preferred language other than English) who screened positive for suicide risk. Descriptive statistics include need for escalation to an emergency room, connection to mental health care, receival of a mental health referral, and attendance at follow-up visits. RESULTS: Minoritized youth were more likely to screen positive and report a history of suicide attempt when compared to non-minoritized peers. Youth identifying as gender expansive had significant elevation in suicide risk. The majority of youth in this sample were already connected to mental health care, with youth preferring a language other than English being the least likely to be connected. CONCLUSIONS: Findings indicate heightened suicide risk for minoritized youth, with gender expansive youth having particularly elevated suicide risk. A need to support youth with a preferred language other than English in getting connected to mental health care was also revealed.

A systematic review of predictors of suicidal thoughts and behaviors among autistic adults: Making the case for the role of social connection as a protective factor.

Autistic adults are a high-risk population for suicidal thoughts and behaviors (STBs). Accordingly, this systematic review aims to review the prevalence of STBs among autistic adults, review the risk and protective factors for STBs in autistic adults, and formulate a disorder-specific conceptualization of risk in this population. We systematically searched PsycINFO and Google Scholar for all studies published prior to March 28th, 2022. We included empirical articles focused on autistic adults, ages 18 years and older, reporting on suicide-related outcomes. In total, 45 peer-reviewed empirical articles were included in the current systematic review. The most frequently studied factors in relation to suicide risk among autistic adults were interpersonal constructs (42.4% of total studies looking at risk/protective factors) and depressive symptoms (36.4% of total studies looking at risk/protective factors). We conclude by summarize two key content areas: exploring social and interpersonal constructs and better understanding the role of depressive symptoms in autism. As researchers continue to explore STBs among autistic adults, it will be necessary to addressing the overreliance on autistic symptoms instead of autism diagnoses, measurement issues of STBs, and a need for treatment adaptations.

Assessing the Validity of the Ask Suicide-Screening Questions in Black Youth.

BACKGROUND: Given the increasing rates of suicide and nonfatal suicide attempts among Black youth in the United States, it is crucial that screening tools are valid in identifying Black youth at risk of suicide. OBJECTIVE: This study assessed the validity of the Ask Suicide-Screening Questions (ASQ) among Black youth. METHODS: This analysis used pooled data from 3 ASQ validation studies of pediatric medical patients aged 10-21 years. All participants completed the ASQ and the gold standard Suicidal Ideation Questionnaire. RESULTS: Of the 1083 participants, 330 (30.5%) were non-Hispanic Black and 753 (69.5%) were non-Hispanic White. ASQ psychometric properties for Black and White participants were equivalent (sensitivity = 94% vs. 90.9%; specificity = 91.4% vs. 91.8%, respectively). CONCLUSIONS: There were no significant differences in ASQ psychometric properties between Black and White youth, indicating that the ASQ is valid for screening Black youth at risk of suicide.

Firearms Access among Pediatric Patients at Risk for Suicide.

BACKGROUND: Approximately 2,900 youth who die by suicide each year in the United States use a firearm. To inform lethal means safety counseling efforts, this study aimed to describe firearm access among youth deemed at risk for suicide in pediatric medical settings. METHODS: Youth who presented to one of four urban pediatric medical centers were screened for suicide risk and access to firearms. Suicide risk was determined by a positive screen on the Ask Suicide-Screening Questions (ASQ) tool. Firearm access was assessed via a structured questionnaire. RESULTS: This secondary analysis analyzed data from 1065 youth aged 10 to 17 years. Overall, 110 (10.3%) participants screened positive for suicide risk. Among those at risk, 28% (31/110) reported guns kept in or around their home, 8% (9/110) had access to a firearm, and 5% (6/110) reported that bullets were not stored separately from the guns. CONCLUSIONS: Over a quarter of youth at risk for suicide reported a firearm stored in or around their home. To ensure the safety of young people at risk for suicide, clinicians should assess whether youth have access to firearms and conduct lethal means safety counseling with youths, as developmentally appropriate, and their parent/caregivers.HIGHLIGHTS28% of pediatric patients deemed "at risk" for suicide in this study reported a firearm kept in or around their home.Among youth at risk for suicide, 8% reported having access to a firearm.These results add further evidence that it is important for clinicians to conduct lethal means safety counseling with patients and their families.

Low levels of discriminant validity between self-report measures of self-esteem, shame, and self-criticism: Implications for the measurement of self-evaluation and creation of the Negative Self-Evaluation Scale.

This article examined the discriminant and convergent validity of commonly used self-report measures of self-criticism, self-esteem, and shame. A confirmatory factor analysis (CFA) using multiple self-report measures of each construct showed low levels of discriminant validity between self-reported self-esteem, shame, and self-criticism and instead demonstrated correspondingly high levels of shared variance. However, bifactor analyses on the items across each measure suggested that self-report measures of self-esteem, shame, and self-criticism may contain distinct characteristics that are underrepresented in current measures of each construct. Based on the factor loadings in item-level bifactor analyses, a new measure, the Negative Self-Evaluation Scale (NSES), was constructed to improve the assessment of the unique characteristics of shame, self-esteem, and self-criticism. Implications for current and future practices concerning the measurement of each construct are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Daily-level assessment of the contexts under which seeking social support relates to risk of suicidal thinking.

INTRODUCTION: Perceived social support is a well-established protective factor against suicidal ideation, yet few studies have examined how actually seeking social support relates to suicidal ideation. We investigated the contexts under which social support seeking may be related to greater, or lesser, suicidal ideation. METHODS: Undergraduates completed ecological momentary assessments up to 6 times daily. Multi-level moderated logistic regressions examined interactions between presence of daily-level support seeking with burdensomeness and loneliness as indicators of same-day and next-day suicidal ideation. RESULTS: Seeking social support was positively associated with same-day, but not next-day reports of suicidal thinking. On days when participants felt burdensome and sought support, they had greater odds of reporting suicidal ideation (OR = 1.659, 95% CI = [1.420, 1.938]), compared with days they felt burdensome but did not seek support. There was no effect of burdensomeness on next-day ideation. There was no significant interaction effect between support seeking and loneliness on same-day or next-day ideation. CONCLUSIONS: Seeking support and feeling like a burden are associated with a greater likelihood of experiencing suicidal ideation. The current results underscore the importance of equipping at-risk individuals with a toolbelt of a variety of coping skills.

Implementing Suicide Risk Screening in a Pediatric Primary Care Setting: From Research to Practice.

OBJECTIVE: To describe the methodological development and feasibility of real-world implementation of suicide risk screening into a pediatric primary care setting. METHODS: A suicide risk screening quality improvement project (QIP) was implemented by medical leadership from a suburban-based pediatric (ages 12-25 years) primary care practice in collaboration with a National Institute of Mental Health (NIMH) suicide prevention research team. A pilot phase to acclimate office staff to screening procedures preceded data collection. A convenience sample of 271 pediatric medical outpatients was screened for suicide risk. Patients, their parents, and medical staff reported their experiences and opinions of the screening procedures. RESULTS: Thirty-one (11.4%) patients screened positive for suicide risk, with 1 patient endorsing imminent suicide risk (3% of positive screens; 0.4% of total sample). Over half of the patients who screened positive reported a past suicide attempt. Most patients, parents, and medical staff supported the implementation of suicide risk screening procedures into standard care. A mental health clinical pathway for suicide risk screening in outpatient settings was developed to provide outpatient medical settings with guidance for screening. CONCLUSIONS: Screening for suicide risk in pediatric primary care is feasible and acceptable to patients, their families, and medical staff. A clinical pathway used as guidance for pediatric health care providers to implement screening programs can aid with efficiently detecting and managing patients who are at risk for suicide.

Level of behavioral health integration and suicide risk screening results in pediatric ambulatory subspecialty care.

OBJECTIVE: This study aimed to characterize suicide risk screening results for youth in pediatric ambulatory subspecialty clinics. METHOD: The Ask Suicide-Screening Questions was administered to patients ages 9-24 years in 12 subspecialty clinics to assess suicide risk, determined by suicide ideation/behavior. The SAMSHA-HRSA standard framework for integrated health was used to categorize each clinic's level of behavioral health integration. RESULTS: 6365 patients completed 7440 suicide risk screens; 6.2% of patients screened positive at their initial screen and 4.1% at subsequent annual screens. There was no dose-response pattern between increasing level of integration and decreasing likelihood of a positive suicide screen. Youth identifying as gender expansive were 3.1 times (95% CI [2.0, 4.9]) more likely to screen positive as compared to cisgender youth, adjusted for age, gender, race/ethnicity, screen type, year, and clinic integration level. CONCLUSION: Results surrounding disparities in suicide risk based on gender identity underscore the importance of further investigating how to optimally identify and manage high-risk, often understudied youth at suicide risk.

A Comparison of Suicide Attempt Histories of Pediatric and Adult Medical Inpatients and Implications for Screening.

OBJECTIVE: A suicide attempt is the most potent predictor of future suicidal behavior, yet little is known about how to manage and respond to reports of attempt histories in hospitalized medical patients. This study aims to describe the prevalence and characteristics of pediatric and adult medical inpatients who report a past suicide attempt. METHOD: Participants were medical inpatients, aged 10-93 years, enrolled in two suicide risk screening instrument validation studies. Participants completed the Ask Suicide-Screening Questions (ASQ) and the Patient Health Questionnaire (PHQ). RESULTS: A total of 1324 medical inpatients (624 pediatric, 700 adult) completed the ASQ, with 114 participants (8.6%) reporting a past suicide attempt (51 pediatric; 63 adults). Comparing youth to adults, there was no significant difference between attempt rates (χ2=0.29, p = 0.59). Youth with a past attempt were significantly more likely to report past week suicidal ideation (OR = 28.22; 95% CI = 5.90, 135.06) and have a history of mental health care (OR = 9.11; 95% CI = 2.59-32.10), compared to those without a past attempt. Adults with a past attempt were significantly more likely to screen positive for depression, compared to those without attempt histories (OR = 5.00; 95% CI = 2.31-10.83). CONCLUSIONS: Nearly 9% of hospitalized medical patients endorsed a past suicide attempt when screened. Since adolescence is a critical time for detecting suicide risk, screening that includes past suicidal behavior may be an important means to identify youth with recent suicidal thoughts. By assessing recency of suicide attempts in adults, medical settings may optimize the effectiveness of how positive suicide risk screens are managed.HIGHLIGHTSRoughly 9% of medical patients reported a past suicide attempt when screened.Adolescence is a critical time for detecting suicide risk and intervening.Assessing past suicide attempts in adults can help with managing positive screens.

Making the Case for Suicide Risk Screening in Outpatient Podiatry Patients: An Opportunity for Injury Prevention.

BACKGROUND: Despite prevention efforts, suicide rates continue to rise, prompting the need for novel evidence-based approaches to suicide prevention. Patients presenting with foot and ankle disorders in a podiatric medical and surgical practice may represent a population at risk for suicide, given risk factors of chronic pain and debilitating injury. Screening has the potential to identify people at risk that may otherwise go unrecognized. This quality improvement project aimed to determine the feasibility of implementing suicide risk screening in an outpatient podiatry clinic and ambulatory surgical center. METHODS: A suicide risk screening quality improvement project was implemented in an outpatient podiatry clinic and ambulatory surgical center in collaboration with a National Institute of Mental Health suicide prevention research team. Following training for all staff, patients aged 18 years and older were screened for suicide risk with the Ask Suicide-Screening Questions as standard of care. Clinic staff were surveyed about their opinions of screening. RESULTS: Ninety-four percent of patients (442 of 470) agreed to be screened for suicide risk and nine patients (nine of 442 [2%]) were screened as nonacute positive; zero patients were screened as acute risk. The majority of clinic staff reported that they found screening acceptable, felt comfortable working with patients who have suicidal thoughts, and thought screening for suicide risk was clinically useful. CONCLUSIONS: Suicide risk screening was successfully implemented in an outpatient podiatry clinic. Screening with the Ask Suicide-Screening Questions instrument provided valuable information that would not have been ascertained otherwise, positively impacting clinical decision-making and leading to improved overall care for podiatry patients.

Limitations of Screening for Depression as a Proxy for Suicide Risk in Adult Medical Inpatients.

BACKGROUND: Medically ill hospitalized patients are at elevated risk for suicide. Hospitals that already screen for depression often use depression screening as a proxy for suicide risk screening. Extant research has indicated that screening for depression may not be sufficient to identify all patients at risk for suicide. OBJECTIVE: The present study aims to determine the effectiveness of a depression screening tool, the Patient Health Questionnaire-9, in detecting suicide risk among adult medical inpatients. METHODS: Participants were recruited from inpatient medical/surgical units in 4 hospitals as part of a larger validation study. Participants completed the Patient Health Questionnaire-9 and 2 suicide risk measures: the Ask Suicide-Screening Questions and the Adult Suicidal Ideation Questionnaire. RESULTS: The sample consisted of 727 adult medical inpatients (53.4% men; 61.8% white; mean age 50.1 ± 16.3 years). A total of 116 participants (116 of 727 [16.0%]) screened positive for suicide risk and 175 (175 of 727 [24.1%]) screened positive for depression. Of the 116 patients who screened positive for suicide risk, 36 (31.0%) screened negative for depression on the Patient Health Questionnaire-9. Of 116, 73 (62.9%) individuals who were at risk for suicide did not endorse item 9 (thoughts of harming oneself or of being better off dead) on the Patient Health Questionnaire-9. CONCLUSION: Using depression screening tools as a proxy for suicide risk may be insufficient to detect adult medical inpatients at risk for suicide. Asking directly about suicide risk and using validated tools is necessary to effectively and efficiently screen for suicide risk in this population.